posted at 2:01 pm on May 15, 2014 by Ed Morrissey

Eric Shinseki may have lucked out in today’s hearing on wait-list fraud at the VA, thanks to a deputy who stuck his foot in his mouth during a discussion about disciplinary action. When Sen. Johnny Isaakson (RT-GA) pressed VA Undersecretary of Health Robert Petzel for an answer on whether manipulating the scheduling system to commit wait-list fraud — as alleged at seven VA facilities so far — would be a firing offense, the answer appears to be It depends:

ISAAKSON: What do you do if you uncover one? Surely you’ve uncovered one. What do you do to hold them accountable?

PETZEL: The individuals are, as you mentioned, held accountable. I can’t give you an example specifically, but if someone were found to be manipulating inappropriately the scheduling system, they would be disciplined.

ISAAKSON: Would that — would they lose their job?

PETZEL: I don’t know whether that’s the appropriate level of punishment or not.

This prompts a couple of questions, especially given the context of the 40 veterans in Phoenix who died waiting for medical care while officials falsified records and destroyed evidence. First, what constitutes an appropriate manipulation of the scheduling system? Second, if facilities are evaluated based on wait list times and the employees are falsifying the records of wait list times, doesn’t that demonstrate an overt motive to cover up bad performance? And third, if this isn’t a firing offense — especially with dozens of veterans dying while being denied treatment — what exactly does constitute a firing offense at the VA?

Shinseki also catches a break from Sen. Dan Coats (R-IN), who blames “cultural issues” of the VA and says Shinseki should stay:

A trio of Republican senators have called for Shinseki’s resignation amid reports that veterans were denied healthcare services. But Indiana Republican Sen. Dan Coats cautioned that the VA chief oversees a dysfunctional organization: “Just by firing the coach doesn’t solve the problem … I want to take a much broader look than just simply satisfying people [to] say, ‘Oh we fired the top guy and now everything is going to be fine.”

Coats, a veteran, added that “there’s cultural problems that go way down deep in the VA system.”

No doubt that there are cultural issues at the VA, and that firing Shinseki won’t solve the problem on its own. But Shinseki has been there for more than five years. Clearly the fact that the VA is “so dysfunctional” has escaped Shinseki and/or goes beyond his capacity to address it. Why would anyone think that the man who spent five years not addressing the culture of incompetence and cover-up should stick around now that it’s been exposed?

Update: Sen. Coats’ office sent me a statement and said Coats did not endorse Shinseki to continue, but isn’t calling for a resignation either:

“As a veteran, I firmly believe our country has a duty to honor and support those who have sacrificed to protect and defend our country. Some issues must rise above politics and the care of our veterans tops the list.

“The reports out of Phoenix and other VA facilities are shocking, outrageous and completely unacceptable. Once all the facts are gathered, sweeping changes must be made at this agency. Right now, the credibility of the entire VA health and benefits system is on the line. Along with addressing allegations of abuse, the excessive delays at VA facilities, including those faced by many Hoosiers, must be eliminated.

“While resignations from top leadership may be necessary, the real problem facing the VA is a culture of mismanagement and indifference to the needs of veterans. The VA must refocus and reorganize to ensure that America’s veterans are receiving the care and support they deserve.”

The Hill changed its headline, but not the story that went along with it.

Blowback

Note from Hot Air management: This section is for comments from Hot Air's community of registered readers. Please don't assume that Hot Air management agrees with or otherwise endorses any particular comment just because we let it stand. A reminder: Anyone who fails to comply with our terms of use may lose their posting privilege.

Shinseki started this 14-day-wait-maximum initiative three years ago. Now, his own people are filing false reports to the federal gummint, including himself. He gets called to The Hill to answer for this, and even his deputy doesn’t

know whether that’s the appropriate level of punishment or not.

Fire ‘em all! Leave blood running in the streets! What the hell are we paying for?!?

And, oh by the way, this is what gummint-run single provider looks like, folks.

Senator Coats: Eric Shinseki is not the “coach”. He’s the Secretary of Veterans Affairs. When you take a position like that, you accept the responsibility and accountability (well, except for Barky). The dysfunctionality alleged is very serious and clearly institutional rather than isolated. A man that was capable of dealing with these issues would not still be dithering after five years in the position.

Or put another way: At what point WOULD you demand his resignation, Senator?

So the VA doesn’t care if a few or thousands of Veterans die. Hey, your not getting an appointment now to survive so just go over and hopefully die before a doctor can see you. Then we won’t have a waiting list. You can’t get anymore efficient then that. The VA executives don’t know if lies and incompetence on the job is grounds for firing. How stupid is that. The VA has security guards. Let them supervise the employee while they empty their personal items from their desk and then escort them to the front door on their termination. A Viet Vet.

Dude, this was like a month ago. If it really mattered, he would have been fired, tried, and convicted the next day. The fact that it took an entire month to bring him to committee means this is just political grandstanding. All of the questions have already been asked, now go back to sleep. /s in spades

“Just by firing the coach doesn’t solve the problem … I want to take a much broader look than just simply satisfying people [to] say, ‘Oh we fired the top guy and now everything is going to be fine.”

1. The VA is not a sports team
2. Shinsecki is not a coach
3. Healthcare is not a game
4. Veterans are people who have earned effective, prompt services

When you fire the top guy of any organization, and make it known you will continue to do so if the performance is lacking, guess what happens?

The next guy that accepts the position has a full understanding of what will happen to him if/when crap like this happens. That means he/she has an incentive to MAKE SURE IT DOESN’T HAPPEN!

The Navy has known this for years, and is absolutely Draconian in its punishment of ship Commanding Officers. Its a tough policy, but it is effective, and every time it happens every CO who reads the news about the latest firing is sure to review his personnel and ship readiness, looking for the same failures they other guy got fired for.

If Coats is thinking that we should have an independent party conduct a full system audit rather than have Shineski fired, I’m definitely behind him on that one.

Yes, absolutely, please, do this!!!!

lineholder on May 15, 2014 at 2:20 PM

Why not do both? And more? Why limit the possibilities?

We too easily are swayed into single courses of action, choosing from Action A or Action B. There’s lots of letters in the alphabet. Lets use’em, without choosing “one or the other”. I choose all of them.

But Shinseki has been there for more than five years. Clearly the fact that the VA is “so dysfunctional” has escaped Shinseki and/or goes beyond his capacity to address it. Why would anyone think that the man who spent five years not addressing the culture of incompetence and cover-up should stick around now that it’s been exposed?

Five years to fix problems and “it depends” about fireable offense if an employee is caught faking wait lists information……..

Well that says all that needs to be said about whether Shinseki should stay or go.

firing Shinseki won’t solve the problem on its own. But Shinseki has been there for more than five years. Clearly the fact that the VA is “so dysfunctional” has escaped Shinseki and/or goes beyond his capacity to address it.

I dunno, was addressing problems part of the hiring criteria or the job requirements? Even if so, good luck getting rid of a gubmint employee who doesn’t want to go!

Here, common sense application to the problem…which is yet another reason why I can’t be President.

- Dissolve Shinseki’s position, and all associated support positions at the FEDERAL level.

- Mandate every State to run the VA at THAT level only: Put it under the control of the State Governors or Highest ranking Officer of the State National Guard.

- Mandate that every month or quarter a report will be released to the public via Internet, TV, etc.

Certain politics ARE local. I think that oversight for the care of Veterans would be more effective if its closer to home…and if a particular State has lousy care, its more likely to be exposed the closer it is.

If it turns out we do need an Federal Investigation, then at the very least fall under jurisdiction of the associated Military branch (Army CID, Air Force OIC, and Navy NIS)…if need be we can have a rotating Task Force made up of of Military and HHS IG office Investigators.

Again, maybe it can work, but at least we streamlined the process some and accountability is more likely to happen.

We too easily are swayed into single courses of action, choosing from Action A or Action B. There’s lots of letters in the alphabet. Lets use’em, without choosing “one or the other”. I choose all of them.

BobMbx on May 15, 2014 at 3:05 PM

Not disagreeing with this at all. I could see firing as many people as necessary. Later. Not first.

We could really use this opportunity to get our hands on data that the government isn’t in the least bit likely to present to the public otherwise. And getting a look at processes…at trending patterns….

An audit conducted by an external third party could let us have a chance to take the data that is collected and use it to present some positive solutions. Approaching it this way instead of going after some sort of blood lust for heads to roll NOW could do a lot to boost public confidence in Republicans.

And the data could be used as a benchmark to evaluate service trending patterns under Obamacare, too. Meaning we would have a precedent to intervene in behalf of the public.

VA employees got bonuses based upon manipulated schedules. They did it for money. In mist organizations that insane termination for cause. In thus case, since people died, they should be charged with so crime.

The real question is, why is the VA trying to provide care to this many people? Maybe it is time to privatize.

tdarrington on May 15, 2014 at 2:47 PM

All the VA wants is more money for their bloated budget to spend on most anything but providing the best of care for veterans and having large numbers of people they are supposed to care for means more money when when they cry for more from CONgress. The vets are merely props for leveraging more money.

Really caring for vets is probably very low on the list of the VAs spending priorities. Maintaining jobs with good salaries and benefits and nicely furnished administrative offices for its bureaucrats is probably high on that spending priority list.

Shinseki has been head of the VA long enough for this to be his fault. If they can’t fire the workers, how about they meet privately with me and some of my Vet friends, we would like to have a “discussion” with them.

If they fire him, it’s done. Blame shifted to Shineski, and public left with the impression that problem solved.

Not for our Vets it wouldn’t be.

We need that system audit. And this is a good opportunity to get one, too.

lineholder on May 15, 2014 at 2:33 PM

I’m not against a thorough investigation; in fact, I’m also in favor of it.

But at the same time, it’s high time to throw some fear into the bureaucratic structure. Make examples of a few screamingly obvious losers like this guy and Lerner. The LoFo’s will enjoy the show, and the ripple effect may help to shift the current course a little bit away from the precipice.

I don’t work at the VA, but I do work in health care. I’d like to raise some points in favor of the average VA employee.

1. The VA is and has been very dysfunctional. It is actually much better than about 20 years ago based on the interactions I have had with the system.

2. The figure I saw was about $800,000 in bonuses for about 3000 employees. That is less than $300 per employee. It was not clear if those bonuses were related to this scheduling issue or were separate, like holiday bonuses or merit bonuses for other reasons.

3. The government is implementing requirements like this everywhere, not just at the VA. It’s like the impossible EPA polution requirements or the impossible fleet mileage requirements. If it is absolutely impossible to meet the requirements, but you are required to document that you did to stay open, what do you do? False documentation. One hospital wants each nurse to do a 15 question pain assessment on each patient every hour, even those that are demented or don’t speak english. Can’t be done.The nurses would have any time to do any other work. She makes it up.

4. While it sounds awful that Veterans died waiting for appointments, without looking at each case, there is nothing to show that they died because they didn’t get seen sooner. Everbody dies. Many of these patients are older. Without case details, it is impossible to tell whether there was a medical intervention that could have exytended their lives in a meaningful way.

5. If they’re talking about firing people at the appointment desk level, that would be very unfair. Scheduling policies are set higher up and the methods to schedule are arbitrary. With a lot of the electronic systems, there are so many workarounds needed to even get a schedule to work, that if the front desk is told to do something, after a while they stop questioning it. I worked one place where patients would just randomly disappear from the schedule. They would show up with an appointment card, but not show on the schdule. No one ever figured out how or why. We thought it was a computer problem.

6. One lesson to be learned is that in many cases it is better to make incremental changes. If you have a 1 year wait time and immediately try to cut it to 14 days, you’ll get faked records. Better would be to cut it to 6 months, then 3, then 1. There is no way any system could make enough changes to go from some of the really long wait times of a year to the demanded 14 days without long term fixes such as hiring a lot of new providers, which is at least $100K per physician/NP/PA.

I don’t work at the VA, but I do work in health care. I’d like to raise some points in favor of the average VA employee.

1. The VA is and has been very dysfunctional. It is actually much better than about 20 years ago based on the interactions I have had with the system.

2. The figure I saw was about $800,000 in bonuses for about 3000 employees. That is less than $300 per employee. It was not clear if those bonuses were related to this scheduling issue or were separate, like holiday bonuses or merit bonuses for other reasons.

3. The government is implementing requirements like this everywhere, not just at the VA. It’s like the impossible EPA polution requirements or the impossible fleet mileage requirements. If it is absolutely impossible to meet the requirements, but you are required to document that you did to stay open, what do you do? False documentation. One hospital wants each nurse to do a 15 question pain assessment on each patient every hour, even those that are demented or don’t speak english. Can’t be done.The nurses would have any time to do any other work. She makes it up.

4. While it sounds awful that Veterans died waiting for appointments, without looking at each case, there is nothing to show that they died because they didn’t get seen sooner. Everbody dies. Many of these patients are older. Without case details, it is impossible to tell whether there was a medical intervention that could have exytended their lives in a meaningful way.

5. If they’re talking about firing people at the appointment desk level, that would be very unfair. Scheduling policies are set higher up and the methods to schedule are arbitrary. With a lot of the electronic systems, there are so many workarounds needed to even get a schedule to work, that if the front desk is told to do something, after a while they stop questioning it. I worked one place where patients would just randomly disappear from the schedule. They would show up with an appointment card, but not show on the schdule. No one ever figured out how or why. We thought it was a computer problem.

6. One lesson to be learned is that in many cases it is better to make incremental changes. If you have a 1 year wait time and immediately try to cut it to 14 days, you’ll get faked records. Better would be to cut it to 6 months, then 3, then 1. There is no way any system could make enough changes to go from some of the really long wait times of a year to the demanded 14 days without long term fixes such as hiring a lot of new providers, which is at least $100K per physician/NP/PA.

talkingpoints on May 15, 2014 at 4:33 PM

I am sorry but these people made a decision to do this, they knew it was wrong and still did it to make themselves look better or for bonuses. “Everybody dies, many of these patients are older” really? It is ok then because they are older? These people are a national treasure and should be treated as such, if nothing else they should get better treatment. You know when Fast and Furious happened agents said this is wrong and did something about it, these people could do the same.

You are attempting to defend the indefensible. I am outraged that in point #6 when you suggest that they go from a 1 year wait period to a 6 month wait period, then work it down to a 1 month wait period. How in the hell did it ever get up to a 1 year wait period? There has been a government run coverup for a long time. And, the best way to cut out the rot is fire those responsible.

I am sorry but these people made a decision to do this, they knew it was wrong and still did it to make themselves look better or for bonuses. “Everybody dies, many of these patients are older” really? It is ok then because they are older? These people are a national treasure and should be treated as such, if nothing else they should get better treatment. You know when Fast and Furious happened agents said this is wrong and did something about it, these people could do the same.

Sven on May 15, 2014 at 5:00 PM

One woman was upset because the patient had stage 4 bladder cancer and died in two months before being seen. If you google it, you will see with treatment the average survival of stage 4 bladder cancer is 4.5-7 months, of which you’re in the hospital a lot and feeling terrible. It’s not like getting to the chemo a month earlier buys you a lot of quality time. It’s not that it’s OK for them to wait because they were older, it’s that the chances of them dying whether they were seen or not is pretty high.

No, the majority of the people did it so they wouldn’t get fired. The upper level people maybe did it for bonuses-the front desk did it to eat, buy shoes for their kids, etc. Think about the unemployment rate. These are not skilled employees. Their job choice is limited.

And that, ladies and gentlemen, is why the federal government is so screwed up. No accountability. I work for the fed and I see it every day. The big reason why I’m actively working to retire this year. Stick a fork in me…I’m done.

You are attempting to defend the indefensible. I am outraged that in point #6 when you suggest that they go from a 1 year wait period to a 6 month wait period, then work it down to a 1 month wait period. How in the hell did it ever get up to a 1 year wait period? There has been a government run coverup for a long time. And, the best way to cut out the rot is fire those responsible.

SC.Charlie on May 15, 2014 at 5:09 PM

OK. All the staff at the VA are now fired. Now what?

There is no one to schedule the patients and no one to see the patients?

Is this better?

VA patients can go elsewhere. I see a lot. They just have to pay for it.

One woman was upset because the patient had stage 4 bladder cancer and died in two months before being seen. If you google it, you will see with treatment the average survival of stage 4 bladder cancer is 4.5-7 months, of which you’re in the hospital a lot and feeling terrible. It’s not like getting to the chemo a month earlier buys you a lot of quality time. It’s not that it’s OK for them to wait because they were older, it’s that the chances of them dying whether they were seen or not is pretty high.

No, the majority of the people did it so they wouldn’t get fired. The upper level people maybe did it for bonuses-the front desk did it to eat, buy shoes for their kids, etc. Think about the unemployment rate. These are not skilled employees. Their job choice is limited.

talkingpoints on May 15, 2014 at 5:17 PM

If they are going to die just let them suffer? Maybe they should be taken out back in shot, they are dying so why not? This sounds like the Obamacrap death panels.

No they did it for bonuses, this is the same corruption found throughout almost every agency in this cluster. The upper level people have to buy shoes etc too. These are not skilled employees, I am not talking about their skills, but their moral courage.

The reason is that the Merit Systems Protection Board requires the deciding official to consider the twelve aggravating and mitigating Douglas factors regarding each employee:

The nature and seriousness of the offense, and its relation to the employee’s duties, position, and responsibilities, including whether the offense was intentional or technical or inadvertent, or was committed maliciously or for gain, or was frequently repeated.

The employee’s job level and type of employment, including supervisory or fiduciary role, contacts with the public, and prominence of the position.

The employee’s past disciplinary record.

The employee’s past work record, including length of service, performance on the job, ability to get along with fellow workers, and dependability.

The effect of the offense upon the employee’s ability to perform at a satisfactory level and its effect upon supervisors’ confidence in the employee’s ability to perform assigned duties.

The consistency of the penalty with those imposed upon other employees for the same or similar offenses in like or similar circumstances.

The consistency of the penalty with the DA Table of Penalties pertaining to various offenses.

The notoriety of the offense or its impact upon the reputation of the Department of the Army.

The clarity with which the employee was on notice of any rules that were violated in committing the offense, or had been warned about the conduct in question.

The potential for the employee’s rehabilitation.

The mitigating circumstances surrounding the offense such as unusual job tensions, personality problems, mental impairment, harassment, or bad faith, malice or provocation on the part of others involved in the matter.

The adequacy and effectiveness of alternative sanctions to deter such conduct in the future by the employee or others.

There is no one to schedule the patients and no one to see the patients?

Is this better?

VA patients can go elsewhere. I see a lot. They just have to pay for it.

talkingpoints on May 15, 2014 at 5:26 PM

No, the majority of the people did it so they wouldn’t get fired. The upper level people maybe did it for bonuses-the front desk did it to eat, buy shoes for their kids, etc. Think about the unemployment rate. These are not skilled employees. Their job choice is limited.talkingpoints on May 15, 2014 at 5:17 PM

Fire them, according to you these are not skilled employees and you said think about the unemployment rate, well I did and came to the conclusion there are a few people that could replace them.

There is no one to schedule the patients and no one to see the patients?

Is this better?

VA patients can go elsewhere. I see a lot. They just have to pay for it. – talkingpoints on May 15, 2014 at 5:26 PM

Talkingpoints you don’t fire those that are only following horrible orders, you fire those those were in position to change the deeply flawed system. I still think that they need to allow all veterans to get treatment a any hospital without any additional cost. The VA is nothing more than another inefficient government bureaucracy where no one is held accountable.

You work in the healthcare industry, right? Then I can understand why your first instinct would be to protect people working in the healthcare industry.

If we don’t find a way to get some safeguards in place against it, Obamacare will move other sectors of the healthcare industry along the same trajectory that the VA has been travelling.

This could be a chance to set a precedent for those safeguards…for both patient AND for employees. This will be one of the first real whistleblower challenges a government-sponsored healthcare system has faced in the US.

We need for front line employees to support the ethical integrity of the healthcare system by doing what is right. Once that is lost “First do no harm” loses all meaning.

Yup. One of my husband’s colleagues quit aboiut 10 years ago for this reason (same cover up, did the whistle blower thing) No change, just one less doc to see the patients resulting in longer wait times.It’s hard to get docs to work at the VA because there are many frustrations to the job.

How many providers would be needed to take the wait time from 1 year to a month? 1000? 10,000? How many more medical assistants? How many more front desk staff? How many more exam rooms? Where is the money to pay for them? Where are you going to find that many docs? Who is going to vet, them, credential them, hire them?

This is just as hard as providing universal health care. The ACA won’t work because it was not thought out or implemented with any grasp of reality. Just the statement that it should be better-wait times should only be a month, without addressing the underlying infrastructure, results in faked records, not better care or outcomes.

When I was a medical student (1980′s)the VA was legendary for its poor care. One resident gave up waiting for a chest xray to be done and took the chest x-ray himself. I don’t remember how many tries he had to do before he figured out the right settings. We did a skit where the lab tech threw the specimens away when they got to the lab (we don’t know if it was true, it just seemed that way). There was the anti-nurse that went around pulling out working IVs. There was the medical student that was called to start an IV because the nurse couldn’t flush the IV. Turns out she couldn’t flush the IV because the patient was dead. The VA does a lot of big studies. In one cardiac study, the patients that got heart bypass surgery did poorly. The authors drew the conclusion that heart surgery wasn’t as good as medical therapy. Others drew the conclusion don’t have your surgery at the VA.

This is not a new problem. It has been this way since at least the 80′s. I don’t know if the VA health system was ever good. Is there anyone that can comment on the prior quality of the VA? How long should it take to fix 30+ years of problems?

You work in the healthcare industry, right? Then I can understand why your first instinct would be to protect people working in the healthcare industry.

If we don’t find a way to get some safeguards in place against it, Obamacare will move other sectors of the healthcare industry along the same trajectory that the VA has been travelling.

This could be a chance to set a precedent for those safeguards…for both patient AND for employees. This will be one of the first real whistleblower challenges a government-sponsored healthcare system has faced in the US.

We need for front line employees to support the ethical integrity of the healthcare system by doing what is right. Once that is lost “First do no harm” loses all meaning.

lineholder on May 15, 2014 at 5:43 PM

I’m not trying to protect them.

I’m trying to point out that rising up in umbrage and demanding that all people with any role be fired WILL NOT FIX THE PROBLEM. It is TOO BIG.

You need to start by hiring a lot more staff. If you fire anyone with any role in this, you would have to get 10,000 replacement hires in addition to the expansion hires needed.

Better: Fire the ringleaders. Hire more providers. Extend the hours-see two shifts so that you don’t need to build new clinic space (although it may be really hard to get double shifts of providers, maybe they could use medics for a triage system or something). Even then, it will probably take months to reduce the backlog.

Is there money to hire more staff? 1000 new docs at $200,000 (salary plus benefits) is $200,000,000. Is there budget money for that other than Obama’s travel budget or IRS office furniture? Does the VA system have that amount in funds that they could get on an emergency basis? And I don’t even know if they could find 1000 docs willing to work at the VA. This is a very hard problem to fix. We should try, but a bunch of politicians yelling “off with their heads” will fix this about as well as going on Twitter will #Bring Back Our Girls.

And yes, this is exactly where the US healthcare system is heading under Obamacare.

I have dealt with Dr. Petzel in the past when he was running the VA Nebraska/Western Iowa division of the VA Health Care System, and I can tell you first hand he is nothing but a number crunching bureaucrat. As a former Veterans Service Officer, I would attend many staff meetings with him, and he is the stereotype of talking in vague terms, without giving any actual, concrete answers. It got so frustrating for me, that I stopped attending those meetings.

It takes 7 years post college to train a primary care doc in the current US system. Four years medical school, 3 years residency. A PA takes 2. Maybe the government can start a PA program where you get free tuition for a PA program in return for working at a VA for two years. Giving time to implement a program-earliest start would probably be fall 2015 you could get additional providers by 2017 and maybe cut your waits to a month by 2018.

They already have programs for underserved areas for MD’s, but no one wants to do 4 years. It’s a lot easier to talk people into two years.

Either that or they can increase the primary care doc salary to $300,000 (for which they would need $400,000,000 instead of $200,000,000.) They would be able to get docs for that kind of money. Maybe $250,000. It would depend on the call. If the call wasn’t bad, and it was just dealing with the VA system, $250,000 would probably do it.

Or they can wait until Obamacare makes practice outside of the VA just as bad as inside and then docs will be just as willing to work at the VA as elsewhere. Maybe the ACA was just a secret plot to improve the relative quality of care at the VA by making other US care worse.

Recent survey had 57% of docs saying they would not go into medicine if they had to make the decision now.

…if facilities are evaluated based on wait list times and the employees are falsifying the records of wait list times, doesn’t that demonstrate an overt motive to cover up bad performance? And third, if this isn’t a firing offense — especially with dozens of veterans dying while being denied treatment — what exactly does constitute a firing offense at the VA?

“While resignations from top leadership may be necessary, the real problem facing the VA is a culture of mismanagement and indifference to the needs of veterans. The VA must refocus and reorganize to ensure that America’s veterans are receiving the care and support they deserve.”

Not going to happen unless the incentives are directed toward that goal (real incentives, not imperial edicts with no basis in reality, with real accountability and controls).
I liked some of the ideas below, but some are still open to the same kind of corruption and incompetence as the current system.
I prefer the privatization model.
Pre-ACA, I would have just said, “Give veterans vouchers to purchase insurance and health care, and exempt them from any “pre-existing conditions” malarkey, since their service-related injuries would otherwise force them out of the market.
Now, I don’t know what would work.

Here, common sense application to the problem…which is yet another reason why I can’t be President.

- Dissolve Shinseki’s position, and all associated support positions at the FEDERAL level.

- Mandate every State to run the VA at THAT level only: Put it under the control of the State Governors or Highest ranking Officer of the State National Guard.

- Mandate that every month or quarter a report will be released to the public via Internet, TV, etc.

Certain politics ARE local. I think that oversight for the care of Veterans would be more effective if its closer to home…and if a particular State has lousy care, its more likely to be exposed the closer it is.

If it turns out we do need an Federal Investigation, then at the very least fall under jurisdiction of the associated Military branch (Army CID, Air Force OIC, and Navy NIS)…if need be we can have a rotating Task Force made up of of Military and HHS IG office Investigators.

Again, maybe it can work, but at least we streamlined the process some and accountability is more likely to happen.

Don’t hold your brteath waiting for any federal worker to lose his job other than possibly some political appointees. The federal union will not permit it and the managers are part of the same union. Cozy isn’t it.